Time: D H M S

You may have noticed that I recently set up a GoFundMe account as an alternate method of letting people help keep going as we enter the 4th Open Enrollment Period.

Until now I've exclusively used PayPal for donations, but decided to add GoFundMe as well to see how that works out.

In addition to my general gratitude, I should also note that anyone who makes a donation is added to the official ACA Signups mailing list. Once a week* I send out a weekly digest including a wrap-up of the past week, along with special bulletins when there's a major ACA-related development.

*(well, nearly every week...occasionally I'm a bit late...)

NOTE: Scroll down for updates as more states are added to average.

After I posted my "I'm Calling It!" post last week re. the 2017 requested rate hikes for the ACA-compliant individual market, I noted that since I originally crunched the numbers for some states as far back as April, the situation in some states has likely changed somewhat due to carriers dropping out, joining in or re-submitting their rate request filings.

Since it would take 10x as much time as it does now (which is already a lot) to recreate the tables and graphs every time there's a change, I've been holding off on doing so until I've accounted for several states...which is what I'm doing here.

I've written a lot in the past about off-season exchange enrollments, otherwise known as SEPs (Special Enrollment Periods). For the most part, SEPs refer to people who enroll in individual policies after the official Open Enrollment period. They're allowed to do so for a variety of reasons: If they move outside of their rating area; if they get married or divorced; if they give birth or adopt a child; if they get out of prison; if they're discharged from the military; or, in most cases, if they lose whatever current healthcare coverage they have due to losing a job, etc.

Over the past 3 years I've estimated that somewhere between 7,000 - 9,000 people sign up for ACA exchange coverage via SEPs every day during the off season, and I've been proven pretty much dead on target on the rare occasions that hard data has been released. Now, that may have dropped somewhat this year since CMS has cracked down on verifying SEP eligibility, but that's still an uknown. Every time someone selects a QHP via one of the ACA exchanges, the official 12.7 million tally for 2016 continues to go up.

At the same time, there has obviously been a lot of of attrition as people drop their policies throughout the year. The official effectuated enrollee number as of March 31st was down to 11.1 million people...a 13% drop from the 12.7 million who had selected QHPs as of the end of January.

Thanks to commenter "InTheKnow" for the heads up:

Wellmark Blue Cross and Blue Shield announced Tuesday that it will narrow its choices for individual Affordable Care Act plans in Iowa and will eliminate ACA individual plans in South Dakota altogether in 2017.

First, some clarification: Wellmark isn't on the exchange to begin with, and wasn't planning on joining it in SD next year, so this is a rare case of a carrier dropping their off-exchange individual market offerings. Since all of Wellmark's indy enrollees in South Dakota are paying full price, this one can't be blamed on APTC enrollees being sicker than average, etc.

Having said that, this does impact around 8,000 off-exchange enrollees in SD.

As for Iowa, it's more of a mixed bag...Wellmark is basically swapping out higher end PPO plans for lower end HMO, which is pretty much the trend everywhere:

Every month I post an entry about the official CMS Medicaid enrollment report, documenting the increase in Medicaid enrollment since ACA expansion went into effect. The numbers were increasing dramatically every month for nearly two years, but started slowing down last fall as most of the expansion states started maxing out on their eligible enrollees.

As of July 2016, total Medicaid enrollment continued to quietly increase for a total of 72.8 million people, with 15.4 million of that being mainly due to the ACA (~10 million via official expansion, ~1 million early additions/transfers and ~4 million "woodworkers").

An important reminder from an anonymous tipster for any Illinois resident who was enrolled in a policy via the now-defunct "Land of Lincoln" Co-Op:

Hey hey. Just wanted to pass some info to you in case you can get it out there. As of last week (not sure the date - either the 15th or the week after) only 34% of LOLH members had taken advantage of the SEP. Spoke with legislators yesterday to get the word out, but since the deadline is Friday, we are trying to get the word out for people to get enrolled.

To review:

Yesterday I hobbled together the weighted average rate hikes (either requested or approved) for the ACA-compliant small group markets across 15 states. In 4 of these states, I hadn't yet tallied the weighted average, so I temporarily used the median increase for each. In the case of Pennsylvania, the range was from a 3.8% decrease to a 33% increase, with a midpoint of around 14.6%.

Today, however, I've actually plugged in the enrollment numbers for each sm. group carrier in Pennsylvania based on their 2017 rate request filings, and have come up with a weighted average of just 7.9%:

(sigh) I thought that last Friday was the deadline for carriers to decide whether they were in or out of the exchange for 2017, but between today's news out of Tennessee and now this, apparently that deadline only applies to those who will be participating in the 4th Open Enrollment Period:

Indiana University Health Plans is pulling out of the Obamacare marketplace in Indiana, just one month after state regulators approved its proposal to raise premiums nearly 15 percent.

IU Health Plans said Monday afternoon it had “restructured its product offerings for 2017” and no longer will be offering individual plans on the exchange. It said the change was necessary “to adapt to new market dynamics” as well as uncertainty created by withdrawals of several other insurers.

Things are looking pretty good for the ACA exchanges in states like Rhode Island, North Dakota and Massachusetts, where they're looking at single-digit rate hikes next year. However, they're looking pretty dire in states like Arizona, Montana and Oklahoma, where the average hikes are likely to be around 50% or higher for many people.

And then there's Tennessee, where Blue Cross Blue Shield asked for and received a 62% rate hike...but even so, just announced that they're dropping out of the individual market completely (both on and off exchange) in 30 counties throughout the state, in the Memphis, Knoxville and Nashville areas:

Bluecross BlueShield of Tennessee is pulling out of three regions in 2017 for their individual/marketplace plans.

The HHS Dept. is very much aware that they have got to get more millennials enrolled in ACA-compliant individual healthcare policies this season; the exchange risk pool has been hovering at around 28% 18-34 year olds for three years running, when the conventional wisdom among those who know more about such things is that they need that number to be somewhere closer to 40% to stabilize the market.

Now, there's a lot of reasons why more young people aren't signing up, including affordability, which of course is the main reason HHS is trying to get more of them to sign up in the first place, creating a bit of a Catch-22. In addition the very "19-25 year olds allowed to stay on their parents plan" provision of the ACA is itself cannibalizing several million potential ACA exchange enrollees, creating some additional irony, since most of those "sub26ers" are presumably enrolled in the employer policies of their parents. Some of these reasons are completely outside of HHS's control

I actually included most of this as an update to my last post, but given how important this is, I figured I should write it up as a separate entry.

A few people have asked whether or not the "25% average hikes" I've estimated which have been cited by pretty much every outlet under the sun also apply to job-based coverage.

NO! Absolutely not!

That 25% weighted national average only applies to the roughly 18 million people enrolled in ACA-compliant individual policies...and even then, roughly half of those folks are mostly protected from the hikes thanks to the federal tax credits. So we're really talking about roughly 9 million people who have to pay the full 25% average increases.

When I decided to once again launch my Annual Rate Hike Estimate project this summer, I knew that this year, the rate increases for the individual market were likely to be significantly higher than in years past. Coming as they are in an election year, as a Democrat and ACA supporter, I obviously took no joy in reporting this truth.

However, a) The data is the data; it would be dishonest of me to try and ignore reality; and b) I knew that if I didn't report the rate increases as accurately as possible, Donald Trump and his Republican Party would flat-out lie about them.

Trump on his ACA replacement plan: "You will be making your own deals and they will be greater than you ever thought possible"

— Betsy Woodruff (@woodruffbets) September 24, 2016

Pretty incredible in new WaPo/ABC poll: On health care, voters favor candidate who can't even describe his plan.

— Dan Diamond (@ddiamond) September 25, 2016

UPDATE: OK, as Diamond notes, this is technically good news, although it's still pretty depressing:

Good news (?): The Post published wrong poll results + fixed 20 minutes ago. Here's corrected data on health care. 

— Dan Diamond (@ddiamond) September 25, 2016

A couple of weeks ago the final approved rates for Maryland's individual market were released; when plugging these into my table, my estimate of the statewide weighted average was 24.8%.

Thanks to the heads up from Louise Norris, however, I now have hard numbers from the Maryland Dept. of Insurance. I was close, but the actual weighted average is slightly higher. In addition, they've provided the small group averages as well:

The Maryland Insurance Administration Approves Premium Rates for 2017 Small Group and Individual Markets
Open Enrollment Begins Nov. 1 in the individual market; Consumers Encouraged to Shop Rates

Lots of healthcare reporters, pundits, executives, providers and politicians are likely issuing a huge sigh of relief at this moment, because after month after month of various insurance carriers announcing that they're dropping off the ACA exchange in certain counties only, state-wide or even dropping out of the individual market entirely (or that they're going out of business altogether, as in the case of four more co-ops), today was the deadline for carriers to officially commit to participating in the 2017 Open Enrollment Period starting on November 1st.